Publicação
Cigarette taxation and socioeconomic inequalities in under-5 mortality across 94 low-income and middle-income countries
| Resumo: | Background: Although increasing cigarette taxes is known to improve child survival, there are few data on their effect on socioeconomic inequalities in child mortality. We investigated the association between cigarette taxation and socioeconomic inequalities in mortality in children younger than 5 years (hereafter referred to as under-5 mortality) in low-income and middle-income countries (LMICs). Methods: This was a longitudinal ecological study. We linked country-level annual data on 94 LMICs, as defined by the World Bank, and annual data on under-5 mortality by wealth quintile from the UN Inter-agency Group for Child Mortality Estimation from 2008 to 2020. We used fixed-effect panel regression models to assess the association of cigarette taxes with absolute and relative inequalities in under-5 mortality by wealth quintile. Findings: Increasing total cigarette tax by 10-percentage-points was associated with reduced under-5 mortality rates in all wealth quintiles. Raising total cigarette tax from 0·0–24·9% to 25·0–74·9% and 75·0% or more of their total retail value was associated with 3·8% (95% CI 0·2 to 7·3) and 7·6% (1·4 to 13·4) decreases in absolute inequality in under-5 mortality, respectively. This finding was mainly attributable to specific tax, which was associated with a 1·4% (0·3 to 2·6) reduction in absolute inequality for each 10-percentage-point increase. We estimated that raising total cigarette taxes to 75·0% or more in all 94 LMICs could have averted 281 017 (196 916 to 362 301) under-5 deaths in 2021. Interpretation: High cigarette taxes are associated with a large decrease in absolute inequality in child mortality in LMICs. These findings support raising cigarette taxes to the WHO-recommended 75% or more of the retail value to protect the poorest children. Funding: Swedish Research Council for Health, Working Life, and Welfare; Stiftelsen Riksbankens Jubileumsfond; European Union's Horizon 2020 Research and Innovation; and UK National Institute for Health and Care Research. |
|---|---|
| Autores principais: | Bannon, Olivia S. |
| Outros Autores: | Been, Jasper V.; Harper, Sam; Laverty, Anthony A.; Millett, Christopher; van Lenthe, Frank J.; Filippidis, Filippos T.; Radó, Márta K. |
| Assunto: | Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being |
| Ano: | 2025 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade Nova de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório Institucional da UNL |
| _version_ | 1868983476048363520 |
|---|---|
| author | Bannon, Olivia S. |
| author2 | Been, Jasper V. Harper, Sam Laverty, Anthony A. Millett, Christopher van Lenthe, Frank J. Filippidis, Filippos T. Radó, Márta K. |
| author2_role | author author author author author author author |
| author_facet | Bannon, Olivia S. Been, Jasper V. Harper, Sam Laverty, Anthony A. Millett, Christopher van Lenthe, Frank J. Filippidis, Filippos T. Radó, Márta K. |
| author_role | author |
| contributor_name_str_mv | Centro de Investigação em Saúde Pública (CISP/PHRC) Comprehensive Health Research Centre (CHRC) - Pólo ENSP Escola Nacional de Saúde Pública (ENSP) Elsevier RUN |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"Bannon, Olivia S.\"},{\"Person.name\":\"Been, Jasper V.\"},{\"Person.name\":\"Harper, Sam\"},{\"Person.name\":\"Laverty, Anthony A.\"},{\"Person.name\":\"Millett, Christopher\"},{\"Person.name\":\"van Lenthe, Frank J.\"},{\"Person.name\":\"Filippidis, Filippos T.\"},{\"Person.name\":\"Radó, Márta K.\"}] |
| datacite.contributors.contributor.contributorName.fl_str_mv | Centro de Investigação em Saúde Pública (CISP/PHRC) Comprehensive Health Research Centre (CHRC) - Pólo ENSP Escola Nacional de Saúde Pública (ENSP) Elsevier RUN |
| datacite.creators.creator.creatorName.fl_str_mv | Bannon, Olivia S. Been, Jasper V. Harper, Sam Laverty, Anthony A. Millett, Christopher van Lenthe, Frank J. Filippidis, Filippos T. Radó, Márta K. |
| datacite.date.Accepted.fl_str_mv | 2025-05-01T00:00:00Z |
| datacite.date.available.fl_str_mv | 2025-05-23T21:15:30Z |
| datacite.date.embargoed.fl_str_mv | 2025-05-23T21:15:30Z |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being |
| datacite.titles.title.fl_str_mv | Cigarette taxation and socioeconomic inequalities in under-5 mortality across 94 low-income and middle-income countries a longitudinal ecological study |
| dc.contributor.none.fl_str_mv | Centro de Investigação em Saúde Pública (CISP/PHRC) Comprehensive Health Research Centre (CHRC) - Pólo ENSP Escola Nacional de Saúde Pública (ENSP) Elsevier RUN |
| dc.creator.none.fl_str_mv | Bannon, Olivia S. Been, Jasper V. Harper, Sam Laverty, Anthony A. Millett, Christopher van Lenthe, Frank J. Filippidis, Filippos T. Radó, Márta K. |
| dc.date.Accepted.fl_str_mv | 2025-05-01T00:00:00Z |
| dc.date.available.fl_str_mv | 2025-05-23T21:15:30Z |
| dc.date.embargoed.fl_str_mv | 2025-05-23T21:15:30Z |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | http://hdl.handle.net/10362/183373 |
| dc.language.none.fl_str_mv | eng |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.subject.none.fl_str_mv | Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being |
| dc.title.fl_str_mv | Cigarette taxation and socioeconomic inequalities in under-5 mortality across 94 low-income and middle-income countries a longitudinal ecological study |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_6501 |
| description | Background: Although increasing cigarette taxes is known to improve child survival, there are few data on their effect on socioeconomic inequalities in child mortality. We investigated the association between cigarette taxation and socioeconomic inequalities in mortality in children younger than 5 years (hereafter referred to as under-5 mortality) in low-income and middle-income countries (LMICs). Methods: This was a longitudinal ecological study. We linked country-level annual data on 94 LMICs, as defined by the World Bank, and annual data on under-5 mortality by wealth quintile from the UN Inter-agency Group for Child Mortality Estimation from 2008 to 2020. We used fixed-effect panel regression models to assess the association of cigarette taxes with absolute and relative inequalities in under-5 mortality by wealth quintile. Findings: Increasing total cigarette tax by 10-percentage-points was associated with reduced under-5 mortality rates in all wealth quintiles. Raising total cigarette tax from 0·0–24·9% to 25·0–74·9% and 75·0% or more of their total retail value was associated with 3·8% (95% CI 0·2 to 7·3) and 7·6% (1·4 to 13·4) decreases in absolute inequality in under-5 mortality, respectively. This finding was mainly attributable to specific tax, which was associated with a 1·4% (0·3 to 2·6) reduction in absolute inequality for each 10-percentage-point increase. We estimated that raising total cigarette taxes to 75·0% or more in all 94 LMICs could have averted 281 017 (196 916 to 362 301) under-5 deaths in 2021. Interpretation: High cigarette taxes are associated with a large decrease in absolute inequality in child mortality in LMICs. These findings support raising cigarette taxes to the WHO-recommended 75% or more of the retail value to protect the poorest children. Funding: Swedish Research Council for Health, Working Life, and Welfare; Stiftelsen Riksbankens Jubileumsfond; European Union's Horizon 2020 Research and Innovation; and UK National Institute for Health and Care Research. |
| dirty | 0 |
| eu_rights_str_mv | openAccess |
| format | article |
| fulltext.url.fl_str_mv | https://run.unl.pt/bitstreams/41da06d4-9d0d-47d4-b47c-2668d872fba1/download |
| id | run_501ca06f57110beef3eec7a3cf16fb4e |
| identifier.url.fl_str_mv | http://hdl.handle.net/10362/183373 |
| inst_facet_str | urn:organizationAcronym:unl{{{_:::_}}}Universidade Nova de Lisboa |
| instacron_str | unl |
| institution | Universidade Nova de Lisboa |
| instname_str | Universidade Nova de Lisboa |
| language | eng |
| network_acronym_str | run |
| network_name_str | Repositório Institucional da UNL |
| oai_identifier_str | oai:run.unl.pt:10362/183373 |
| organization_str_mv | urn:organizationAcronym:unl |
| person_str_mv | Bannon, Olivia S. Been, Jasper V. Harper, Sam Laverty, Anthony A. Millett, Christopher van Lenthe, Frank J. Filippidis, Filippos T. Radó, Márta K. |
| publishDate | 2025 |
| repo_facet_str | urn:repositoryAcronym:run{{{_:::_}}}Repositório Institucional da UNL |
| reponame_str | Repositório Institucional da UNL |
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| service_str_mv | urn:repositoryAcronym:run |
| spelling | engenBackground: Although increasing cigarette taxes is known to improve child survival, there are few data on their effect on socioeconomic inequalities in child mortality. We investigated the association between cigarette taxation and socioeconomic inequalities in mortality in children younger than 5 years (hereafter referred to as under-5 mortality) in low-income and middle-income countries (LMICs). Methods: This was a longitudinal ecological study. We linked country-level annual data on 94 LMICs, as defined by the World Bank, and annual data on under-5 mortality by wealth quintile from the UN Inter-agency Group for Child Mortality Estimation from 2008 to 2020. We used fixed-effect panel regression models to assess the association of cigarette taxes with absolute and relative inequalities in under-5 mortality by wealth quintile. Findings: Increasing total cigarette tax by 10-percentage-points was associated with reduced under-5 mortality rates in all wealth quintiles. Raising total cigarette tax from 0·0–24·9% to 25·0–74·9% and 75·0% or more of their total retail value was associated with 3·8% (95% CI 0·2 to 7·3) and 7·6% (1·4 to 13·4) decreases in absolute inequality in under-5 mortality, respectively. This finding was mainly attributable to specific tax, which was associated with a 1·4% (0·3 to 2·6) reduction in absolute inequality for each 10-percentage-point increase. We estimated that raising total cigarette taxes to 75·0% or more in all 94 LMICs could have averted 281 017 (196 916 to 362 301) under-5 deaths in 2021. Interpretation: High cigarette taxes are associated with a large decrease in absolute inequality in child mortality in LMICs. These findings support raising cigarette taxes to the WHO-recommended 75% or more of the retail value to protect the poorest children. Funding: Swedish Research Council for Health, Working Life, and Welfare; Stiftelsen Riksbankens Jubileumsfond; European Union's Horizon 2020 Research and Innovation; and UK National Institute for Health and Care Research.application/pdfenCigarette taxation and socioeconomic inequalities in under-5 mortality across 94 low-income and middle-income countriesSubtitleena longitudinal ecological studyBannon, Olivia S.Been, Jasper V.Harper, SamLaverty, Anthony A.Millett, Christophervan Lenthe, Frank J.Filippidis, Filippos T.Radó, Márta K.Centro de Investigação em Saúde Pública (CISP/PHRC)Comprehensive Health Research Centre (CHRC) - Pólo ENSPEscola Nacional de Saúde Pública (ENSP)ElsevierHostingInstitutionOrganizationalRUNe-mailmailto:run@unl.ptrun@unl.ptISSNIsPartOf2468-2667URNIsPartOfPURE: 116655066URNIsPartOfPURE UUID: bb180d73-fa19-4c79-9e76-d7958ce4dedeURNIsPartOfScopus: 105003741222URNIsPartOfPubMed: 40312082URNIsPartOfWOS: 001494741400001DOIIsPartOf10.1016/S2468-2667(25)00065-92025-05-23T21:15:30Z2025-052025-05-01T00:00:00ZHandlehttp://hdl.handle.net/10362/183373http://purl.org/coar/access_right/c_abf2open accessPublic Health, Environmental and Occupational HealthSDG 3 - Good Health and Well-being634252 bytesliteraturehttp://purl.org/coar/resource_type/c_6501journal articlehttp://purl.org/coar/access_right/c_abf2application/pdffulltexthttps://run.unl.pt/bitstreams/41da06d4-9d0d-47d4-b47c-2668d872fba1/download |
| spellingShingle | Cigarette taxation and socioeconomic inequalities in under-5 mortality across 94 low-income and middle-income countries Bannon, Olivia S. Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being |
| status | SINGLETON |
| subject.fl_str_mv | Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being |
| title | Cigarette taxation and socioeconomic inequalities in under-5 mortality across 94 low-income and middle-income countries |
| title_full | Cigarette taxation and socioeconomic inequalities in under-5 mortality across 94 low-income and middle-income countries |
| title_fullStr | Cigarette taxation and socioeconomic inequalities in under-5 mortality across 94 low-income and middle-income countries |
| title_full_unstemmed | Cigarette taxation and socioeconomic inequalities in under-5 mortality across 94 low-income and middle-income countries |
| title_short | Cigarette taxation and socioeconomic inequalities in under-5 mortality across 94 low-income and middle-income countries |
| title_sort | Cigarette taxation and socioeconomic inequalities in under-5 mortality across 94 low-income and middle-income countries |
| topic | Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being |
| topic_facet | Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being |
| url | http://hdl.handle.net/10362/183373 |
| visible | 1 |